KGPMTA Membership Registration Form

Unit

Name

Current Designation

Gender

Date of Birth

Mobile

Email

Marital Status

Name of Spouse

Occupation of Spouse

Office Address

Residential Address

Transaction No./ UPI No Only for new registration.

(Tap on QR code to open UPI app on mobile)

Bank Account Details:
Name: KGPMTA
Account Number: 67122806323
IFSC: SBIN0070111
Branch: Medical College, Kottayam